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Clinical instructor feels I'm not competent?

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by Holopugs Holopugs (New) New

So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... 😔 Please no harsh comments I'm feeling low enough, hoping it's not just me.

While the instructor's criticisms may be valid, there are ways to constructively criticize and ways not to talk to a student. Using the word "horrible" is not specific or measurable, making this less than a good teaching moment. If her goal was to upset you and throw you off your mark, it seems she succeeded. Turn the critique into a positive by not allowing this to derail you. And BTW, worry about your performance on the job when the time comes. You have enough on your plate now.

shibaowner, MSN, RN, NP

Has 1 years experience.

I'm so sorry you are going through this. I went through the same thing during the ABSN program - kept being told I lacked confidence, which made me feel less confident - a vicious cycle. However, I graduated and am now a nurse practitioner. Oddly, I got nothing but praise for my clinical skills during the MSN program and I did feel confident!

Here's my advice:

1. Talk to your clinical instructor. Suck up big time. Ask them for a plan with specific things you can do to improve your skills. Your goal is to pass. Make sure the plan includes regular dates to get feedback from the instructor - you don't want to reach the end of the semester and get failed.

2. Talk to your advisor and ask for suggestions as well. They may be able to find a tutor for you.

3. Try to get a tutor if you need one - it could be a fellow student who has great skills who could use a little money from tutoring.

4. Most nursing students do feel nervous, but can usually hide it. What are you doing/saying that makes your instructor feel you lack confidence? For example, if a patient asked me a question and I didn't have the answer on the tip of my tongue, I would think and then answer. For some reason, the instructor hated this. A friend suggested that when in this situation, I respond, "That is a great question! Give me a second to make sure I give you the information you need (or something similar)" That gave me a few seconds to compose myself w/o having the "deer in the headlights look"

Good luck!

HermioneG, BSN, RN

Specializes in Emergency Nursing. Has 1 years experience.

So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... ������ Please no harsh comments I'm feeling low enough, hoping it's not just me.

Hi studentnursemorgan,

I'm really sorry that you're having this anxiety. I, myself, have ADD and struggled tremendously in the beginning. With that being said, repetition and practice should steady you. The problem here might be that you simply haven't had enough practice yet.

Here are some suggestions that hopefully can help:

1) You've identified a weak spot, such as passing medication and giving heparin. Great! Now you must practice doing this at home. I struggled with this, so I had my husband lay in bed and pretend to be a patient. I would get random things (peanuts, m&ms, raisins, etc) and pretend he was my patient. I would simulate the introduction, checking full name and DOB, scanning the patient, checking the "MAR", explaining which pretend medication was which, and basic patient education. I would do this over and over and over and over and over again until it started to click better. Part of getting confidence is practicing it!

2) I noticed that you said that you were particularly stressed about giving a heparin shot. Do you think this could possibly be because you know you're going to cause discomfort for the patient? I personally figured out that I was struggling with injections because I knew I would cause my patient slight pain/discomfort and I myself wasn't comfortable with that. It helped me to remember that I'm causing some discomfort for a very important purpose, and the patient allowing me to give them the shot means that they know that you're going to cause them some discomfort but is letting you do it anyways. You know its going to cause them discomfort, the patient knows it will cause them discomfort, and you're both doing what is necessary to help them avoid much more uncomfortable things in the long run. The patient understands this is going to hurt and yet is still okay with it. That helped me be more confident.

3) I would also suggest watching videos on giving shots and meds. Watch the techniques. Something else that was really helpful that a nurse told me one time was to not be flamboyant and stab the patient with the needle. Be gentle and chill while you're doing it. Talk to the patient while you're doing it if you can.

OP, honestly, if you had seen me my first year and then saw me again as I prepared to graduate you would've never believed I was the same person. I used to get so scared and stressed, my hands would shake badly whenever I tried to give someone a shot, and I was just generally a nervous person. But keep your head high and try to project confidence. I know its hard, I had many patients comment early on about how badly my hands shook and I would force myself to laugh and tell them that I just needed to lay off the coffee. The key is to be safe and also be confident. You CAN do it.

I went from thinking I sucked and feeling like I would never make it to doing my capstone in the ER and now I'm starting in a New Grad program at a level 1 trauma center at the ER of my dreams. You will NOT be a horrible nurse because you care enough to post here and ask for help, so clearly you want to fix this. And you will. It takes time and practice. Maybe your confidence won't blossom this quarter since your clinical instructor seems to be hurting rather than helping, but practice and keep pushing through and it will blossom. As you enter into the nursing field as a new grad you'll look back and marvel at how far you have come throughout nursing school. And as you finish out your bumpy first year as a nurse and start getting into the groove of things you'll look back and really REALLY see how far you've come.

Have faith and keep asking for help. Its definitely NOT just you.

-HermioneG

I'm a fellow nursing student and I know how nerve-wracking it can be - especially if you feel intimidated and anxious.

I *personally* do not feel that your instructor's comments were tactful at all. That being said, you will need to work on (at least) appearing confident. Patients can and will get scared if you look and sound like you don't know what you're doing (I had that happen once during my med-surg clinical).

Practice these tasks in your head - not just the administration of the shot itself, but what you will say to the patient and how you will say it. Prepare for questions - including questions you may not immediately be able to answer.

Additionally, talk to your instructor and ask specifically what they expect from you and how you can meet those expectations throughout the duration of your clinical.

Good luck! :)

I'm not a nurse as of yet, just a student but i hope you take what I have to say to heart. I really don't think you should be projecting into the future the way that you are. Just because you get nervous and anxious, doesn't mean you are stupid or incompetent. I too have anxiety and it can be debilitating so I get it. It also seems like there may be an underlining self-esteem issue going on. I'm not saying that to be judgmental, i'm saying it because you sound a lot like me at times, and I know that it has to do with my self-esteem not being as good as it could or should be. I really really think you need to take a step back and assess all the things you ARE good at. You got into nursing school because you're smart. If you need to write out and say affirmations to yourself in the mirror everyday do it. For me, I know when I'm getting in my head and feeling less than or not good enough, I need to reach out to the people in my life who know and love me and tell them how i'm feeling and whats going on. I get feedback and advice from the people who have my back and know how my soul ticks. F**k what that teacher had to say. She doesn't know you, nor is what she said supportive or positive. So chin up. Be proactive in your own confidence and success. There is no shame in admitting you are having a hard time and need help/love/advice/pep talk whatever. Just be willing to put in the work to get your head back in a good place, whatever that may look like for you.

BBboy

Specializes in PICU, CICU. Has 2 years experience.

Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong

fibroblast

Has 5 years experience.

So I have always had anxiety. It's followed me my whole life, including ADD and I feel it's possible for some sort of slight autism... long story short I am in my second year of nursing school, currently in med-surg. I get slightly anxious when passing meds specifically heparin injections, mostly because my clinical instructor can be so intimidating. I didn't think I was doing so bad until my instructor pulled me aside today and told me how horrible I'm doing and how she will not be giving me the opportunity to visit the OR like she is allowing my other classmates to do this clinical. She told me she doesn't trust me because I have no confidence. I am very concerned that this issue will follow me throughout my career and that I'll either be a horrible nurse or be terminated for making mistakes and being so nervous all the time. Am I alone in this, is there anyone else who has made mistakes and felt this way or am I just really stupid.... í ½í¸” Please no harsh comments I'm feeling low enough, hoping it's not just me.

Your mistakes are your own and so is your anxiety as far as your practice goes. Do you only get nervous in front of others when evaluated? Don't let these darned clinical instructors tell you that you are a horrible.

meanmaryjean, DNP, RN

Specializes in NICU, ICU, PICU, Academia. Has 44 years experience.

Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong

Worst advice EVER!

OP: Did your instructor use the word 'horrible' or is that your interpretation of her conversation with you? Can you not see that she is trying to HELP you? That she recognizes your deficiency and is trying to help you overcome it?

I get that anxiety can color the words you hear in these crucial conversations. My advice is to look for the truth in what the instructor tells you, own it, and - with the instructor -formulate a plan to improve.

shibaowner, MSN, RN, NP

Has 1 years experience.

To OP: Hope you have received the support you need here! I really feel for you.

In my previous post, I forgot to suggest that you see a psychiatrist or psychologist. You need to find out if you do have ADHD, general anxiety, or autism. If you don't, that will be a relief. If you do, then you can be properly treated, which will greatly help you.

Best wishes.

HermioneG, BSN, RN

Specializes in Emergency Nursing. Has 1 years experience.

Don't listen to your instructor. During my first hospital rotation my instructor pulled me aside and made me redo an additional clinical day by myself because she wasn't so sure about me as I was taking on a higher patient load than she wanted and wasn't too knowledgeable about medications at the time. Flash forward to now and I'm an LPN after finishing the NCLEX in 40 minutes in the minimum and will sit for my RN boards this December after graduation. I will say that I'm a completely different student and nurse from where I was at that time but it just shows with time that you can prove anybody wrong

Sometimes our harshest critics can shine light on some uncomfortable truths. There's no help in being surrounded by a bunch of people who just tell you what you want to hear. The struggle is not letting it cut your confidence, but rather taking it in stride.

My favorite nurse of all time (and my senior capstone preceptor, who will also *hopefully* be my New Grad preceptor) raked me through the coals sometimes when discussing my weaknesses. He was never mean about it, but he was very up front. It hurts to hear, but its absolutely necessary in order to get better.

The OP should push through in spite of the clinical instructor but she should never ignore their observations. You'd better believe that my preceptor's constructive criticism stung, but I worked my butt off and eventually earned both his respect and a letter of recommendation from him for the New Grad program. Don't let the criticisms crush you, but make sure to listen to them because they can help you get better.

I don't think what the instructor said was constructive.

I think it's normal for student nurses to have some anxiety and hesitate to make decisions during school, that shouldn't mean you don't get OR exposure.

Making you nervous and doubt yourself was wrong (unless you were not trying to focus, distracted by friends or something, didn't sound like that).

I have panic disorder and I have worked with a surgeon doing liposuction and tummy tuck in clinic before nursing school with no nurse above me (just other assistants and a director of surgery). In nursing school now for rn

Though I had panic and had to really take care of myself with meds, the job was great. I gained the respect of my surgeon and the staff and it was a great experience

1. Take care of your anxiety. Plenty of people work in jobs like these on the anxiety meds. But if some counseling or other method works for you do that certainly.

2.Study very hard and be sure of your answers. This is what I have to do to minimize anxiety, and is the best thing imo. You said you were unsure of yourself. Why? Are your afraid because you don't trust your knowledge, or don't trust your memory? You need to study so that you don't worry about knowledge, then practice so you don't worry about errors. You may need more practice than others.

3. Ask the professors (not just that one) for advice. This is their job and thats what you are paying them for. Ask exactly what is expected of you and what you need to do to get there. Do you need more knowledge (about how heparin should be given? ) or, practice?( Do you need to practice with the technique or verifying Rs or something else?)

4. If you are not working hard or are distracted, they do have reason to keep you out of OR. Be honest with yourself and you may have to change your habits if that's the case.

5. Talk to others with experience and see what things they did. Some have trouble communicating with doctors. Some are afraid of a mistake. Figure out what they do to build your confidence

6. OR is supposed to be routine, at its very best, not full of drama and unknowns (though you should be prepared for those). This is a common misconception which leads to anxiety. You don't have to worry about that as much as you may think but you do need to be prepared because you'll have less "stage fright" as I call it.

I am just in nursing school, I'm not in any rotation, but when I worked for the surgeon I made sure I was really prepared for cases by watching videos if we did something different, also reading about the procedures in journals and what are some common issues that happen or different variations.

Edited by operations

aflahe00

Specializes in Med/surg/ortho. Has 7 years experience.

u can definitely relate when you talk about your anxiety and having no confidence. I had the same problem during my synthesis clinical which was the final clinical I took before I graduated. I was terrified of my instructor she was so intimidating! she could sense my lack of self confidence that's for sure. one day during clinical me and 2 other students were shawdowing a nurse on the telemetry unit. The desk phone

Rings and it's my instructor summoning me to the icu. I get there and she quickly tells me I'm going to insert a foley in a female and she says this right in front of the patient. I stupidly said "I've never done this before " which she snapped back at me that I should never say that in front of a patient. I don't think I got it in on the first try but eventually I got it in. After wards in group she asked me how I thought I did to which I replied "terrible ". She seemed shocked by my answer.

Looking back she made me realize that the only thing standing in my way is me.

I also went through the same thing last semester. My advice to you (how I got through the semester) is tell yourself you got it! Go through each clinical morning on the way there and say I'm going to do great, I'm going to be a great nurse it is just one persons interpretation of me. Know all your drugs, and what they do. Be great with your patients. Study hard. Know exactly what questions she is going to ask before she even asks them from you so you can be right on top of it. (labs, contraindications, what it does), go to the skills lab and practice how to pass medications again or watch videos if you need to! You will get through it. My clinical instructor made me feel so stupid in front of my classmates, my patient, and nurses. I hated going to clinical, I did not want to go anymore at all. We talked about it and I thought she was going to fail me! She told me I was being to rude about it when I was just trying to explain to her how I felt, but once I did she completely changed how she acted toward each of us. Maybe you want to try that. I CAN say after that semester, even though it was awful I now have an amazing clinical instructor who lets us asks questions, is not confrontational, and trusts us. Just put on your happy face and do great.

Hi! I get really anxious about doing almost anything in clinical, but especially meds and IVs. I also have ADD, and I'm constantly nervous that I'm missing an important detail. I think practicing the skills as much as possible in the lab and at home first in a relaxed, fun but also focused way can help. I also think watching realnurses do it in a clinical setting at least a couple times also helps me to feel less like I'm taking a practical test I'm going to fail and more like I'm learning a new job skill. Having a clinical instructor who is harsh and yells at you can definitely make it worse. I get why they act like that, it is a big responsibility, but that just means that most of us students are already intrinsically motivated to learn and anxious about making mistakes. The better option is to be present, supportive and to provide clear expectations. Of course, you can't always choose your instructor but hopefully you'll get a better one at some point. Until then it might be a good idea to pair off with a classmate and play off of each others strengths and weaknesses.

Last advice, fear and anxiety go away with exposure. So even though you might want to avoid administering meds because you feel like you're bad at it or you're going to be criticized. The more you can push through that tendency and seek out experiences administering meds (with help if you don't feel comfortable) the less scary and more natural it will become. (This trick also works for non nursing things like fear of heights or spiders or social anxiety).

In the meantime, make sure you're making an effort to be nice to yourself. Make hot tea and tell yourself how awesome you are, all the things you've already accomplished that you didn't know you could, and how you're just getting more and more awesome over time.

Good luck!!

Another basket case soon to be boss student

Listen to your instructor but don't take what she says personal. She is trying to keep you from killing someone.

I am sorry you are having difficulties. I would suggest that you:

1. Ask for a conference with your clinical faculty and the course lead/director. You deserve an interim performance feedback and a plan for improvement.

2. The previous posters have offered excellent advice about seeking medical evaluation for anxiety.

3. Read your undergraduate/student handbook carefully for policies & procedures about handling clinical performance problems. Make sure your faculty are following their own rules. Every program has a handbook but no one ever pulls it out until a problem comes up.

4. Consider meeting with a counselor/advisor from the student disabilities unit in your school. If there is any possibility of anxiety/ADD/ADHD-you may benefit from extra time or other modalities to help you succeed. Every school typically has such an area and you typically need an evaluation/screening by their counselors.

Good luck!